CHAP ONLINE ENROLLMENT INSTRUCTIONS

NOTE: Before starting the application have available your Agency address, phone number and fax and your EIN and NPI numbers

Go to www.chapinc.org

Click on Accreditation Process

Click on Application for Accreditation

Page 1

Enter EIN Number

Enter name and email address

Create password

Click on Create Account

Page 2

Enter Agency name

CEO (you) name and title

CHOOSE Single location

Branches -0 Sub-Units – 0

CHOOSE - Independent Free Standing

CHOOSE – Proprietary For Profit

Is Parent Applying – Answer YES

Enter Street Address, Name of Contact (You), phone and fax

Contact Us

Fill out the form below for a no obligation consultation and one of our friendly consultants will get back to you shortly.

Page 3

Enter Agency name and address

CHOOSE - Main Office

Enter NPI number

 Leave Medicare BLANK

 Leave Medicaid BLANK

Leave License BLANK

Enter Date that is ten days prior to the date of the Application

MILES TO PARENT -- ENTER 0

Page 4

CHOOSE CORE

CHOOSE HOME HEALTH

Page 5

CENSUS –0

Accreditation with – No Medicare accreditation

Total Admissions –O

Page 6

Review Information and Submit

Within a couple of hours you will receive an EMAIL acknowledgment. Save a copy and forward it to your contact at 21st Century. Print it out and mail it to the address given in the acknowledgment with a check for $500.00.

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